title: A head-to-head comparison of periprocedural coagulability under anticoagulation with rivaroxaban versus dabigatran in patients undergoing ablation of atrial fibrillation.
abstract: OBJECTIVE
  Two new oral anticoagulants, rivaroxaban and dabigatran, with no need for anticoagulation monitoring, are available for patients with atrial fibrillation (AF). We aimed to compare their anticoagulant effects and safety when used during the AF ablation periprocedural period.
  
  
  METHODS
  Patients undergoing AF ablation were randomly assigned to receive rivaroxaban 15 mg once daily (N = 30) or dabigatran 110 mg twice daily (N = 30). Rivaroxaban was withheld on the morning of the day before the ablation, and dabigatran was discontinued from the evening of the day before the procedure. Both anticoagulants were then resumed after haemostasis of the access site. D-dimer levels were measured just before the ablation, at the end of the ablation, and at 24 h and 48 h after the procedure.
  
  
  RESULTS
  The baseline D-dimer levels were identical in both groups. However, D-dimer levels increased more markedly following the ablation procedure in patients receiving rivaroxaban than in those receiving dabigatran (mean ± standard deviation from 0.62 ± 0.16 to 1.09 ± 0.38 μg/mL vs from 0.59 ± 0.08 to 0.75 ± 0.17 μg/mL; p < 0.0001). The rate of rebleeding from the access site was similar in patients receiving rivaroxaban and those receiving dabigatran (33 vs 27%; p = 0.78).
  
  
  CONCLUSIONS
  As compared with dabigatran, rivaroxaban may increase the risk of hypercoagulability when used during the periprocedural period of AF ablation, suggesting a potential rebound effect of rivaroxaban or a mismatch between its half-life and dose regimen.
authors.affiliation: Department of Cardiology, Nagoya Daini Red Cross Hospital, Nagoya, Japan, rjrgw059@ybb.ne.jp.
authors.forename: Akinori
authors.initials: A
authors.lastname: Sairaku
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Monami
authors.initials: M
authors.lastname: Ando
authors.forename: Haruo
authors.initials: H
authors.lastname: Hirayama
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Nakano
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Kihara
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000601:surgery*; D001562:Benzimidazoles / Q000627:therapeutic use*; D000069604:Dabigatran; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000627:therapeutic use*; D000069552:Rivaroxaban; D013876:Thiophenes / Q000627:therapeutic use*; D015091:beta-Alanine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D005338:Fibrin Fibrinogen Degradation Products; D009025:Morpholines; D013876:Thiophenes; C036309:fibrin fragment D; D015091:beta-Alanine; D000069552:Rivaroxaban; D000069604:Dabigatran